EDUCATING PARENTS: From a flyer DHS is distributing as part of its outreach to parents.

Arkansas Advocates for Children and Families has been sounding the alarm on the potential lapse of ARKids benefits for some 100,000 children in the state if families fail to renew their coverage under new federal eligibility requirements.

Just to be clear, this isn't an issue about either the state or federal government kicking kids off of their insurance, or creating unreasonable barriers to enrollment. It's about technical changes in the renewal process and the disruptions that inevitably occur when even small changes are made to a huge program. Advocates explains:

In mid-2015, DHS began sending notices to over 200,000 families telling them to renew coverage for children in their home. Information was also sent to schools, providers, and community partners. Still, DHS recently announced that over 100,000 kids (about 42,000 families) may lose coverage if families do not renew soon.

So why is this suddenly a problem, if coverage must be renewed every year? DHS will be renewing many ARKids cases for the first time since new federal requirements were rolled out on determining eligibility. Since the state was unable to do these renewals automatically, each family has to complete the renewal process online or return the application mailed to their homes.

That doesn't mean, however, that policymakers are entirely blameless in this situation. Arkansas has fallen short on outreach efforts around changes to Medicaid programs in general — something that was at least partly an affirmative decision by legislators opposed to Obamacare..

ARKids, the state's program providing health and dental coverage to children from low- to middle-income families, doesn't have anything to do with Obamacare directly. But it is one piece of the unwieldy apparatus that is the American health care safety net (the bulk of its funding comes from the federal Children's Health Insurance Program), and because the Affordable Care Act affected all parts of the health care system, programs like ARKids will inevitably undergo changes as well. As Advocates wrote in another recent blog post, that means proactive outreach is more important than ever, so that Arkansans are informed about changes such as the new eligibility determination process.

Problems with newborn applications have also created coverage gaps for kids. Again, challenges with the eligibility and enrollment system created barriers. These barriers prevented babies from being quickly enrolled in coverage, even when the mother was already enrolled in Medicaid. The system problem has been corrected, but there is still a backlog of over 4,000 applications that have not yet been approved. Recently, DHS reported they have trained additional workers in order to clear the backlog in the next 60 days.

Arkansas's eligibility and enrollment framework has been a mess since the Department of Human Services began working on an overhaul of the system under the administration of Democratic Gov. Mike Beebe. Projects have consistently ran over budget and over schedule; labyrinthine technical issues and bickering vendors have plagued it from the beginning. Last year, Gov. Hutchinson's administration made the existing problems worse by imposing unreasonably short response deadlines on private option beneficiaries, leading to thousands of people needlessly losing coverage. But for what it's worth, the eligibility and enrollment problems with newborns that Advocates raises are probably issues that Hutchinson's government inherited.

UPDATE: I spoke to DHS spokesperson Amy Webb about outreach efforts the agency has been performing on both the newborn enrollment issue and renewals for existing ARKids families.

To inform families about the need to renew coverage, DHS has sent three separate letters over the course of several months, Webb said, beginning last summer. The most recent notice went out in January; here it is.

As of January, about 170,000 families had responded and renewed, out of around 212,000 statewide. That leaves 42,000 families — representing about 103,000 children, Webb said — who could potentially lose coverage if their parents don't get in touch with DHS to renew.

"The ACA changed the way we determined eligibility for certain categories of Medicaid," Webb said, explaining the need for the renewals. "We needed some new information that we did not have in our old system. The big thing that it required is ... household tax filing status."

When DHS first began seeking renewals, she said, "we were concerned by the lack of response, and so we did things that we don't normally do to try to get families involved. We created a flyer about the renewals in English and Spanish and sent it to every school nurse in the state. We heard anecdotally that some nurses were printing it out and putting it in every backpack. ... We sent it to all the libraries in the state. We sent it to the 800 childcare centers that accept vouchers."

The department also ran radio ads in 60 counties and reached out to food banks, Arkansas Advocates, the Interfaith Alliance, the Health Department, Childrens' Hospital and the Arkansas Chapter of the American Academy of Pediatrics, Webb said. It posted the flyer in every DHS county office. (The flyer in question is the one posted above.) "So we really tried to do everything we possibly could to reach out to these families."

"We will begin closing cases at the end of February ... in terms of nonresponse," Webb said. "We'll start closing ARKids B first, since those families are more likely to have increased their income and are no longer eligible." If families are indeed still eligible and have their cases closed, they'll have a 90 day window to respond and get their case reopened.

Webb said the issue with newborns not receiving ARKids coverage was the result of a software problem that has now been fixed.

"If a mom is on pregnancy Medicaid and has a baby, the newborn gets one year of coverage through Medicaid. They're automatically eligible," Webb said. That is, if a baby is born to a mother receiving Medicaid, that infant automatically becomes an ARKids beneficiary for the first year life. The state's new eligibility system, though, failed to route such infants into the system automatically.

"We went to IBM [the vendor responsible for this piece of the eligibility software] and said 'this is not working,' and they said 'you're right,' and created a fix. ... but it was only a fix moving forward. So there were all these newborns in the meantime that got caught in that issue." DHS has contacted medical providers around the state and asked them to provide a list of mothers/children who might have been left off of the list.

As of February 1, "there were 4,045 newborn cases that had been submitted to us by providers. The plan is to have them done by 60 days," or by the end of March.

That doesn't mean all of those mothers have had to pay for medical care for their infants out of pocket, though some surely have. "Most providers have been providing care with [the infant's insurance situation] in a pending status. But not all of them have, so there are moms out there who have not been getting coverage for their kids, or have been paying out of pocket."